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This is the great merit of Da Rold's book: it is a truly interdisciplinary study of paper in medieval England. Da Rold argues that paper had affordances that parchment simply did not have. The humanists, however, did not set the trend, and in Italy, as in England, hybrid books, in which paper bifolia nestle inside parchment ones in each quire, are common. [Extracted from the article]

As the number of digital archives increases – both traditional archives that have been digitized and 'born digital' collections – so, too, grows the number of tools and methodologies through which they can be better understood. This article explores how archives can be 'mapped' digitally, using network analysis to examine epistolary networks built on the State Papers archives of England. It will outline some of the core contributors to the archives, while also pointing to smaller actors and collections, whose place in the epistolary network and the archives are best revealed when viewed at scale within this 'mapping' process. This article demonstrates that – as with any other historical dataset – understanding the archives and the ways in which they are constructed is vital to further quantitative analysis, and how this is turn may bolster digital historical narratives. As such, this article not only demonstrates the outcomes of adopting digital methodologies, and how they may shape ongoing historical research and narratives, but also illustrates the ways in which the adoption of these quantitative measures allows for a critical reconsideration of historical sources, their origins and the ways in which they can be used. [ABSTRACT FROM AUTHOR]

Objective: To identify the 100 most-cited articles in DH and analyze their characteristics. Material and Methods: A search was performed on the Web of Science (WoS) and the 100 most-cited articles were selected. The following data were extracted: citations, year of publication, authorship, institution, country, journal, language, study design, topic of interest, conflict of interest (COI), and sponsorship. The VOSviewer software was used to visualize bibliometric networks. Poisson regression analysis was performed to measure associations between several citations and the characteristics of the studies. Results: The number of citations ranged from 346 to 48. The most-cited article was published in 1997 by Holland in the Journal of Clinical Periodontology. This journal published the most papers, followed by the Journal of Oral Rehabilitation and Journal of Dentistry. Laboratory research, review, and clinical trial were the study designs most prevalent. Reviews (p<0.05; PR= 1.853) and method development studies (p<0.05; PR= 1.853) had a more chance to present more citations. The main topics of interest were the clinical effectiveness of desensitizers and in vitro analysis of dentin morphology. Sponsorship and COI were underreported. England and USA presented the greatest number of citations and connections in the coauthorship network map. Conclusion: Most of the articles were original research, and their topics of interest were mainly the clinical effectiveness of desensitizing agents and dentin morphology. [ABSTRACT FROM AUTHOR]

Objective: This work aims to analyze the 100 most cited papers in radiotherapy or chemoradiotherapy for cervical cancer. Methods: The 100 most cited papers in radiotherapy or chemoradiotherapy between 1990 and 2020 were identified with Thompson Reuters Web of Science citation indexing on August 24, 2020. The publication years, source titles, countries/regions, total citations, and average citations per year were extracted from the Web of Science. The research type and research domain were classified by the authors. Results: These 100 papers were cited a total of 28,714 times, and the median number of citations was 169.5 (ranging from 116 to 1,700 times). The most cited paper was "Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer" by Rose et al., with a total citation of 1,700 times. The International Journal of Radiation Oncology Biology Physics (40 papers), Radiotherapy and Oncology (14 papers), and the Journal of Clinical Oncology (12 papers) published the largest number of papers. USA (47 papers), Austria (18 papers), Canada (13 papers), and England (13 papers) contributed the largest number of papers. Image-guided adaptive brachytherapy (IGABT) had the largest number of papers (25 papers). Concurrent chemotherapy was the most cited research domain, with 10,663 total citations and 592.4 citations per paper. Conclusion: In the present study, we conducted a bibliometric analysis of the 100 most cited papers in radiotherapy or concurrent chemoradiotherapy for cervical cancer in the past 30 years. IGABT and concurrent chemotherapy were the most cited research domains. [ABSTRACT FROM AUTHOR]

Background: Several cross-sectional studies have investigated the incidence of urinary Congo-red dye positivity in women with preeclampsia (PE), compared to unaffected pregnancies, and reported very high sensitivity and low false positive rate in the diagnosis of PE. Objective: To determine the performance of the urinary Congo-red dot paper test at 35–37 weeks’ gestation in the prediction of delivery with PE at ≤2 and >2 weeks after assessment. Methods: This was a prospective observational study in women attending for a routine hospital visit at 35+0 to 36+6 weeks’ gestation in a maternity hospital in England. Urine samples were collected and the Congo-red dot paper test was used to assess the degree of Congo-red dye positivity. The test uses a scoring system from 1 to 8 and the higher the score the greater the degree of Congo-red dye positivity. We examined and compared the degree of Congo-red dye positivity in the groups that delivered with PE at ≤2 and >2 weeks with those that remained normotensive. Reproducibility was assessed by examining the inter- and intra-observer reliability of scoring on stored images with the researchers blinded to previous results. Results: The study population of 2140 women included 46 (2.1%) that subsequently developed PE (2.1%). The urinary Congo-red dot test was positive in 8.3% (1/12) and 2.9% (1/34) that delivered with PE at ≤2 and >2 weeks from assessment and in 0.2% (4/2094) of the unaffected pregnancies when the cutoff for Congo-red dye positivity was ≥5. The respective values when the cutoff used was ≥3 were 66.7%, 23.5%, and 16.5%, respectively. The intraclass correlation coefficient for the inter-observer reliability was 0.926 (95% CI 0.890–0.953, p<.0001) and Cohen's kappa coefficient for the intra-observer reliability was 0.904, p<.0001. Conclusions: The performance of the urinary Congo-red dot paper test at 35–37 weeks’ gestation in the prediction of PE is very poor. [ABSTRACT FROM AUTHOR]

Background: Mothers who have children removed from their care often have complex needs. These women have poor health outcomes and are dying earlier than their peers from preventable and amenable causes. Yet there is little known about how health care services might mitigate these risks. This study aimed to listen to the voices of women who had children removed from their care to understand their experiences of health and healthcare., Methods: We used a narrative approach to collect and analyse interview data with six mothers who had experienced child removal in England. Each participant was asked to reflect on their life and main health challenges., Results: Three narrative subplots were developed to consolidate experiences of unmet health need: (i) 'on paper you're normal': narratives of complex need, (ii) 'in my family, everyone had issues': narratives of whole family need and (iii) 'I'm still mummy, no matter where they are': narratives of maternal identity and health., Conclusions: Findings highlight limitations within current systems of support, including a culture of distrust and women falling between the gaps of services. Women's narratives illustrate opportunities for health intervention, especially immediately following child removal., (© The Author(s) 2023. Published by Oxford University Press on behalf of Faculty of Public Health.)

This paper critically examines the White Paper, Opportunity for all, published by the UK Government's Department for Education (DfE) in March 2022. This has a number of recommendations for schools in an attempt to 'level up'. In particular, there is a promise to deliver 'a fully trust-led system with a single regulatory approach [and] a clear role for every part of the school system'. Such a system provides a serious challenge to the way that Religious Education (RE) structures in England are currently built: in short, when Local Authorities no longer have schools under their control – what is the point of a SACRE? Arguing that the 'local settlement' for RE serves two purposes – a curricular purpose and support and monitoring purpose – this paper will suggest that future RE curricula will be planned at the Trust level, with the monitoring and support functions being moved from the local to the regional. [ABSTRACT FROM AUTHOR]

The book "Women's Labour and the History of the Book in Early Modern England" edited by Valerie Wayne explores the question of whether women have a book history in early modern England. The book utilizes a range of new original sources and analysis to provide a resounding answer that women did indeed have a significant role in the book trade and cultural life during this period. The book is praised for its successes but also acknowledges its limitations, particularly in terms of its focus on English borders and its definition of "woman." Despite these constraints, the book is considered an essential piece of women's history and book history for future scholars and students. [Extracted from the article]

Purpose: This paper aims to outline the initial pilot use of the client complexity matrix (CCM), an outcome measure developed for an NHS Adult Intellectual Disabilities Intensive Support Team (IST) in the West Midlands of England. Design/methodology/approach: A mixed method approach was used to report the results and evaluate the use of the CCM within this IST. The CCM was trialled for six months between January 2022 and June 2022. CCM scores pre and post IST intervention were analysed via t-test, and qualitative feedback from clinicians is detailed. Findings: Analysis suggests the CCM captures service success showing a significant decrease in complexity and risk post-intervention. Qualitative comments from clinicians were generally positive; however, there were requested changes regarding specific presentations, use of labels/language and for a digital version. Research limitations/implications: The tool is not co-constructed with the client. Because of this IST's caseload, the sample size was small. Only one clinician was asked to complete the CCM pre and post intervention. Future use of the measure will encourage two clinicians to complete the measure to evidence its inter-rater reliability. Each client's specific presentation was not explicitly analysed here. Practical implications: The CCM will be updated using the feedback from clinicians and from the peer review process. Research that examines the generalisability of this measure to other IST services would be beneficial. Originality/value: The CCM appears to fill a gap in outcome measurements for this IST service which looks at breadth and depth of client complexity and risk. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of font size and paper thickness on the response to, and completion of, a self-completion postal questionnaire among older people with joint pain., Study Design and Setting: Randomized trial. People aged 50 years and older with joint pain who consulted a general practitioner at one of five general practices in Central Cheshire were sent a postal questionnaire. Questionnaire format (large or small font size, thick or thin paper) was randomly allocated using a 2 x 2 factorial design., Results: Questionnaires were received from 502 out of 650 participants (crude response 77%). Response was significantly higher for participants receiving questionnaires with a larger font size (79.3% vs. 75.2%; hazard ratio 1.26, 95% confidence interval: 1.02, 1.56). Paper thickness had no significant effect on response. Completion (measure by assessing double-page turnover error) was increased in participants receiving questionnaires printed on thicker paper (3.2% vs. 7.1%; P=0.049) but was not affected by font size., Conclusion: This study demonstrates that questionnaires in larger font and on thicker paper may produce higher and more complete responses than surveys using standard size font and standard thickness paper, and should therefore be considered in studies among older people.

This contribution examines Sismondi's money, banking and credit theories and explores his public debt analysis (1803–1838) to connect the instability of market economy with his vision of the social contract. A detailed analysis is offered of the evolution in Sismondi's opinion on the nature of money and the banking system, and the part it plays in his trade cycle theory. Sismondi's monetary thought is then contextualised with a discussion of his policy-mix in relation to the Napoleonic war financing in Continental Europe. Connections with the upcoming flood of literature in England on the bullion controversy are also offered. Remarks are then suggested on the progressive emergence of an "art of public borrowing" according to which the people who provide the money also control the government. Finally, some reflections are proposed on the explicit connection established by Sismondi between budget deficits, the (ab-)use of inconvertible paper money and the partial collapse of the social contract initiated by banks and the governments using it. The entrenched instability of a market economy (discussed in an earlier article) is reinforced by the banking/credit system that works along similar line than any wealth-producing firm. Hence, thanks to the financial system, wealth does grow faster but at the expense of social justice. [ABSTRACT FROM AUTHOR]

Citation rates can be used as an indicator of the influence and relevance of scientific papers. The present study analyzed the 100 most-cited articles related to erosive tooth wear (ETW). The top 100 most-cited papers focusing on ETW topics were collected from the Web of Science database on November 11, 2020. The following bibliometric data were extracted from papers: title, authorship, institutions, countries, number of citations, year of publication, journal title, study design, topic, and keywords. Scopus and Google Scholar were searched to compare the number of citations. The VOSviewer software was used to generate collaborative network maps for the authors and keywords. The number of citations of the 100 most-cited papers ranged from 71 to 330 (average: 97.44). The papers were published between 1949 and 2015. Caries Research (28%) and The Journal of Dentistry (16%) presented the majority of papers. Laboratorial (44%) and observational studies (33%) were the most common study designs. The most studied topics were epidemiology (31%) and the erosive potential of substances (drinks, foods, or medicines) (22%). The countries with the highest number of most-cited papers were England (32%), Germany (18%), and Switzerland (10%). The University of Bern was the institution with the most papers (10%). Lussi A was the author with the highest number of papers in the top 100 (14%). The most common keyword was "dental erosion" with 64 occurrences. The top 100 most-cited papers related to ETW were composed mainly of laboratorial and observational studies focusing on epidemiology and the erosive potential of substances., (© 2022 S. Karger AG, Basel.)

In principle, it is possible for a couple to get married in a register office in England or Wales for £127 (including the cost of giving notice and a certificate). In this article, we draw on empirical research to show how limited this option is in practice. Its availability is constrained by the scarcity of register offices limited slots for weddings, and the addition of other fees not provided for in the regulations. Its accessibility is often not obvious from local authorities' websites, and the administration of such a wedding varies hugely, with some local authorities treating it as a no-frills legal procedure, and others regarding it as a significant ceremony that is incomplete without music or a reflective introductory speech by the superintendent registrar – even if the couple wanted neither. With significant numbers of couples having a register office wedding because the marriage ceremony they choose to have to reflect their beliefs is not legally binding, there is a need to address these issues of availability, accessibility and administration so that couples are not put off or discriminated against. Further research is also needed to explore how these issues impact those with limited means. [ABSTRACT FROM AUTHOR]

Background and objectives: Pulp bleaching is a concern of many conservationists. Research has been conducted with the aim of evaluating some traditional bleaching materials used in the preservation of documents and books, such as hydrogen peroxide and sodium borohydride, which shows that these materials do not significantly improve the mechanical properties of historical papers. Also, investigating the effect of reducing agents on oxidized papers has shown the effectiveness of tert-butylamine borane complex. In another study, five dyeing processes with oxidizers (calcium hypochlorite, hydrogen peroxide in two concentrations, light bleaching and potassium permanganate) and two dyeing processes with reducing agents (sodium borohydride and tert-butylamine borane) were compared. Their effect on alfa cellulose (Whatman filter paper) and two different historical papers have been investigated. The results indicate that all the tested dye removal methods have led to a clear increase. Due to the differences of opinion, in this research, the effectiveness of two reducing agent sodium borohydride and sodium dithionite on the appearance and structural characteristics of paper is investigated. Methodology: In this research, Whatman Filter Paper No. 1 (Whatman Filter Paper No. 1) made in England with a thickness of 180 microns, diameter of 11 cm, basis weight of 87 grams per square meter and ash content of 0.06% was used. . Chemical reagents including potassium persulfate, sodium borohydride and sodium dithionite reagent grade were prepared in a laboratory from Merck, Germany.Three solutions including potassium persulfate (2% by weight/volume), sodium borohydride (1% by weight/volume), sodium dithionite (1% by weight/volume) in distilled water (distilled water, pH; 7), to perform tests on zinc. Paper samples have been used by immersion. Whatman filter paper samples were subjected to oxidation in 2% peta persulfate in distilled water for 2 days (48 hours) and then the samples were immersed. Next, the identified samples were modified by two solutions of sodium borohydride and sodium dithionite 1% in distilled water for 1 to 5 hours and then purified in distilled water. Also, the samples were subjected to accelerated aging according to ASTM standard number D4714-96 at a temperature of 90±2 centigrade and a relative humidity of 50±2% for 384 hours. Test methods include potentiostat, colorimetry, tensile strength, pH measurement, scanning electron microscope and infrared examination. Results: The results show that potassium persulfate is the most neutralizing solution among the three solutions used on the first day, and it also indicates the reducing power of two solutions of sodium dithionite and sodium borohydride, which according to the test results, sodium borohydride is the reducing power compared to sodium dithionite. The sample prepared with pH 3.92, after accelerated aging, was accompanied by an increase of several units of pH after modification with two reducing substances. Examining the data obtained from the tensile strength test shows that in comparison with the tested samples with a tensile index of 1.06, the samples modified with sodium borohydride and sodium dithionite increased the index in all five modified periods. The infrared spectrometry investigation of the samples modified with sodium borohydride and sodium dithione shows that this old material improves the structure of cellulose after aging by changing the C=O bonds to C-O and reducing the area of 1640 cm-1.. The reduction of the absorption band in the region of 1640 cm-1 has been opened in almost all time cases with this material compared to the modified sample. Based on the data, samples modified with sodium borohydride and sodium dithionite had a significant increase (approximately 25 units) in the Lfactor (light-darkness) after aging, indicating that two substances have increased the brightness of the sample by reviving the color compounds. In the microscopic examination of the surface of the fibers, in the samples identified with potassium persulfate, local separation of the fibers is observed. In the samples modified with sodium borohydride and sodium dithionite, fibers with higher consistency and entanglement are observed. Conclusion: Double bonds and carbon groups in paper samples formed with potassium persulfate have been the main responsible for the yellowness and darkness of the paper. The reducing agents, sodium borohydride and sodium dithionite reduce this aldehyde and ketone to hydrocarbon. With the loss of multiple conjugates, the light absorption of the paper is reduced and this causes the paper to brighten. The double bonds and their regeneration also cause rearrangement of the cellulose chain, which has resulted in increasing the mechanical resistance and strength of the paper samples. [ABSTRACT FROM AUTHOR]

The nineteenth century witnessed the creation of a 'paper Panopticon' designed to capture information about offenders in England, especially those who were transported to Australia. This article considers the effectiveness of this new record-keeping system and asks whether convicts had some agency within it. These questions are explored through a macroscopic analysis of the recording of convict ages in nineteenth-century England and Australia, made possible by the Digital Panopticon project. By using the methodological opportunities opened up by digital technologies, we can test the accuracy of historical records in new ways, and in the process develop a better understanding of the encounter between state authority and convict agency. [ABSTRACT FROM AUTHOR]

This paper builds on a previous article describing an innovative approach to enhance the service user and practitioner's experience of novel collaborative approach to service improvement. It aims to explore the impact of this through the voices of service users as collaborators and co-authors. The Recovery and Collaborative Care Planning Café (RCCPC) designed with World Café principles, created a safe space to foster inquiry and learning about recovery between service users, carers, and practitioners in an NHS Trust. An important part of the method was in changing conversations towards recovery and living well with conditions applying CHIME concepts (Connectedness, Hope, Identity, Meaning, and Empowerment). Story is a qualitative method known as a well-established effective means of engaging others in sharing experiences and perspectives. Through the stories of service users' experiences participating in the RCCP Cafe, it was clear that they felt that CHIME concepts had a positive impact on the way that their conversations evolved. Accounts of how these conversations had resulted in personal growth and increased connectedness emerged. [ABSTRACT FROM AUTHOR]

Examines the difficulties in identifying and tracking paper stocks in London, England. Role of paper in the history of bibliographical scholarship; Difficulties in identifying sheet quality, paper quantity and watermarks; Analogy of author Carter Hailey relevant to identifying tracking paper; Impact of technological innovations on book study and book history.

Purpose: The paper examines three English research papers on self-neglect, from 1957, 1966 and 1975, discussing them in the context of more recent thinking and the statutory framework in England. Design/methodology/approach: In reviewing the three research papers, developments and points of continuity in the field of self-neglect were identified and are discussed in this paper. Findings: In light of the findings of the three articles, the present paper traces some of the classificatory refinements in this field that have taken place since the papers were published, notably in respect of hoarding and severe domestic squalor. Some of the difficulties in making judgements about behaviour thought to breach societal norms are described, and the challenges practitioners face in intervening in cases, particularly where the person concerned is refusing assistance, are examined. Originality/value: By drawing on the historical research context, the paper contributes to our current understanding of the field of self-neglect. [ABSTRACT FROM AUTHOR]

Many of the "signs and tokens" described in alchemical texts relate to colour, from the Crow's Bill signifying putrefaction to the philosophical solvents disguised as Green Lions, Red Dragons, and Grey Wolves. While the process of yellowing, or citrination, often appears in medieval recipes, it seems to have interested commentators less than the more familiar processes of blackening, whitening, or reddening. Yet beyond these canonical colours, yellowness turns out to be ubiquitous in alchemy and its associated craft practices, both in Latin texts and vernacular translations. This paper uses source criticism and experimental reconstruction to interrogate the role of yellowness at the beginning, middle, and end of practice, focusing on fifteenth- and sixteenth-century England. As starting ingredients, yellow vitriol and litharge offered the potential for transmutation but also posed problems for identification and preparation. As an intermediate stage, yellowness offered promising signs of future success, in the form of dramatic colour changes and unexpected products. But yellowness also offered an end in itself, as appears from the many citrination processes attested in recipe collections which aimed to imitate the properties of gold – suggesting that yellowing was prized as a significant indicator of chemical change across diverse areas of craft practice. [ABSTRACT FROM AUTHOR]

The philosopher David Hume is renowned in international monetary economics for his 1752 analysis of the specie-flow mechanism of international adjustment. He has been viewed in the literature as an abstract theorist, writing without direct practical experience of public policy or monetary affairs. This paper shows Hume in the unfamiliar role of a British diplomat negotiating the settlement of the outstanding paper money of New France after the British conquest of Canada. [ABSTRACT FROM AUTHOR]

Reports on the efforts of Health Secretary John Reid to publish the book "White Paper" in England. Concerns over the need of reducing the prevalence of obesity in the country; Way of responding to several public health issues; Availability of the book.

Objective: The association between higher registered nurses (RN) staffing (educational level and number) and better patient and nurse outcomes is well-documented. This discussion paper aims to provide an overview of safe staffing policies in various high-income countries to identify reform trends in response to recurring nurse workforce challenges., Methods: Based on a scan of the literature five cases were selected: England (UK), Ireland, California (USA), Victoria and Queensland (Australia). Information was gathered via a review of the grey and peer-reviewed literature. Country experts were consulted for additional information and to review country reports., Results: The focus of safe staffing policies varies: increasing transparency about staffing decisions (England), matching actual and required staffing levels based on patient acuity measurement (Ireland), mandated patient-to-nurse ratios at the level of the nurse (California) or the ward (Victoria, Queensland). Calibration of the number of patients by the number of nurses varies across cases. Nevertheless, positive effects on the nursing workforce (increased bedside staffing) and staff well-being (increased job satisfaction) have been consistently documented. The impact on patient outcomes is promising but less well evidenced., Conclusion: Countries will have to set safe staffing policies to tackle challenges such as the ageing population and workforce shortages. Various approaches may prove effective, but need to be accompanied by a comprehensive policy that enhances bedside nurse staffing in an evidence-based, objective and transparent way., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Adopting a children's rights perspective, a critique and analysis underpinned by documentary research methodology was undertaken in order to assess the extent to which the government's Green Paper (Department of Health and Social Care and Department of Education, 2017. Transforming children and young people's mental health provision: a green paper. Available at: https://www.gov.uk/government/consultations/transforming-children-and-young-peoples-mental-health-provision-a-green-paper (accessed 7 December 2017)) addresses the mental health and well-being needs of refugee children and young people in England and Wales, identifying strengths, limitations and challenges for future policy and practice. Findings suggest that there is much of potential benefit to refugee children and young people's future mental health and well-being. However, a paradigm shift, explicit in implications, scale and time frame, will be required, if the Green Paper is to achieve those changes in attitudes, practice and service delivery which it anticipates. We argue that this Green Paper's overarching challenge is that it is premised on Western-centric models in its understanding of the experiences of refugee children and young people, and management of trauma and mental health. It fails to recognize the meanings and significance of culture, and of diversity and difference, and the need to invest in all communities in facilitating engagement and support for children and young people's mental health issues.

Background: Cardiovascular disorders (CVD) are the single greatest cause of mortality worldwide. In the UK, the National Health Service (NHS) has launched an initiative of health checks over and above current care to tackle CVD. However, the uptake of Health Checks is poor in disadvantaged communities. This protocol paper sets out a UK-based study (Sussex and Nottingham) aiming to co-produce a community delivered CVD risk assessment and coaching intervention to support community members to reduce their risk of CVD.The overall aim of the project is to implement a tailored-to-context community engagement (CE) intervention on awareness of CVD risks in vulnerable populations in high, middle and low-income countries. The specific objectives of the study are to enhance stakeholder' engagement; to implement lifestyle interventions for cardiovascular primary prevention, in disadvantaged populations and motivate uptake of NHS health checks., Methods: This study uses both qualitative and quantitative methods in three phases of evaluation, including pre-, per- and post-implementation. To ensure contextual appropriateness the 'Scaling-up Packages of Interventions for Cardiovascular disease prevention in selected sites in Europe and Sub-Saharan Africa: An implementation research' (SPICES) project will organize a multi-component community-engagement intervention. For the qualitative component, the pre-implementation phase will involve a contextual assessment and stakeholder mapping, exploring potentials for CVD risk profiling strategies and led by trained Community Health Volunteers (CHV) to identify accessibility and acceptability. The per-implementation phase will involve healthy lifestyle counselling provided by CHVs and evaluation of the outcome to identify fidelity and scalability. The post-implementation phase will involve developing sustainable community-based strategies for CVD risk reduction. All three components will include a process evaluation. A stepped wedge cluster randomised trial of the roll out will focus on implementation outcomes including uptake and engagement and changes in risk profiles. The quantitative component includes pre and post-intervention surveys. The theory of the socio-ecological framework will be applied to analyse the community engagement approach., Discussion: Based on the results ultimately a sustainable community engagement-based strategy for the primary prevention of CVD risk will be developed to enhance the performance of NHS health care in the UK. The Trial Registration number is ISRCTN68334579., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

The Canadian physician Sir William Osler is a key figure in the history of modern medicine. He encouraged lifelong learning for doctors, starting with bedside teaching. Contemporary with Old World figures such as Pasteur in Paris and Virchow in Berlin, he played a major role in raising awareness among clinicians of the importance of the scientific basis for the practice of medicine. He championed a rational approach to treatment and did much to encourage avoidance of 'unnecessary drugging' by prescribers. He is credited with playing a key role in improving education of medical students and postgraduate education of doctors, with important benefits for the care of hospital patients. He also had a major influence on his medical colleagues through founding and leading medical societies. A century on from his death in December 1919, his specific contributions and how he achieved them are not well known. The aim of this article is to consider the evidence that Osler was an influential medical leader and to reflect on the extent to which the achievements which resulted from his leadership are relevant to modern clinical medicine. Questions of interest include his leadership style, what made for his success as a leader, his medical achievements both in North America and in England, his own insight into leadership and how he was viewed by his peers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Short-fibre paper residuals (deinking paper fibre (DPF) or paper mill sludge) represents a major waste formed during the processing of recycled paper and is known to contain significant quantities of copper. It is often spread onto agricultural land to help increase soil pH and improve structure by adding soil organic matter (SOM). A number of agricultural sites in England and Wales that had received large and repeated applications were sampled to investigate the long-term effects of this practice on soil quality and plant copper content. We found that the composition of DPF waste has changed significantly between 1999 and 2006 with concentrations of Cu increasing and organic matter content declining. Whilst repeated additions of DPF to agricultural land always increased soil Cu, an associated increase in SOM was not always apparent. There was no link between SOM and bioavailable Cu nor between soil bioavailable Cu and plant Cu. In contrast to previous reports, our findings indicate that improvement in soil quality following the long-term application of DPF was site-specific and in some cases it may have reduced soil quality rather than enhanced it. [ABSTRACT FROM AUTHOR]

A literary criticism is presented of the English novel "Bleak House," by Charles Dickens. Particular focus is given to the characters of the book's scavenging through rubbish, including in search for waste paper. An overview of the book's representation of the England's economic and social conditions in the 19th century, including of the slums of London, England, is provided.

Purpose: To report distribution of codes associated with a rheumatoid arthritis (RA) diagnosis recorded in Clinical Practice Research Datalink (CPRD) Aurum compared to the previously validated CPRD GOLD database as a critical step toward making decisions about CPRD Aurum's suitability for medical research.Patients and Methods: We analyzed the distribution of codes for RA diagnoses, labs, and treatments in the new CPRD Aurum database, compared to the CPRD GOLD database by selecting relevant indicators of RA diagnosis, treatment, and clinical care. We included all patients in England in CPRD Aurum and CPRD GOLD with an incident diagnosis code for RA on or after 1 January 2005 and at least two years recorded data before first RA diagnosis.Results: We found 53,083 and 18,167 patients with a new diagnosis code for RA in CPRD Aurum and CPRD GOLD, respectively. In both databases approximately 67% were female with similar mean ages at first diagnosis. There were few differences in RA-related recording patterns between the two data sources. Before first RA diagnosis, CPRD Aurum patients had more RA-specific labs and other supporting clinical codes. After diagnosis, CPRD Aurum patients had more RA diagnoses coded and more often had 10+ general RA labs than patients in CPRD GOLD. More CPRD GOLD patients had 10+ prescriptions for conventional disease-modifying antirheumatic drugs (cDMARD) compared to CPRD Aurum. Otherwise, the distribution of drugs used to treat RA was similar between databases. The standardized incidence of RA was similar between databases.Conclusion: Overall, among patients with a diagnosis code for RA, recording of diagnoses, prescription drugs, and labs were similar between CPRD Aurum and CPRD GOLD. Slight differences were found for a few variables, but overall, we found consistency between the databases. In addition, standardized incidence of RA was similar between databases. [ABSTRACT FROM AUTHOR]

This paper explores Digital Poverty (DP) in England by adopting the DP Alliance's theoretical framework that includes both Individual Determinants (individual capability and motivation) and Circumstantial Determinants (conditions of action). Such a framework is interpreted as an expression of Strong Structuration Theory (SST), by situating the connection between social structure and human agency in an intertwined relationship. We focus on new potential vulnerabilities that are connected to DP in England by drawing on a survey conducted on a randomised stratified sample (n = 1988) of parents aged between 20–55 with children at school. Exploring parents' experience in the COVID-19 era, we identified economic factors and having children with disabilities as important predictors connected to Digital Poverty. Additional socio-demographic traits (such as age and education), parental status, lifestyles and digital behaviours also play a role in predicting some of the determinants linked to Digital Poverty. This paper adds to SST by empirically exploring how individuals use the Internet according to their metabolised embodiment of external determinants. [ABSTRACT FROM AUTHOR]

The use of Multi-criteria Decision Analysis (MCDA) was investigated in an exercise using a panel of local residents and stakeholders to assess the options for managing waste paper on the Isle of Wight. Seven recycling, recovery and disposal options were considered by the panel who evaluated each option against seven environmental, financial and social criteria. The panel preferred options where the waste was managed on the island with gasification and recycling achieving the highest scores. Exporting the waste to the English mainland for incineration or landfill proved to be the least preferred options. This research has demonstrated that MCDA is an effective way of involving community groups in waste management decision making., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: A large number of nondigitized electrocardiograph (ECG) strips are routinely collected in larger cohort studies such as the ADDITION study (Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care). These ECG strips are routinely read manually but may contain overlooked information revealing cardiac autonomic dysfunction. The aim of this study was to investigate whether clinical information may be lost using manual R wave to R wave (RR) interval measurements in the calculation of heart rate variability (HRV) in patients with type 2 diabetes mellitus (T2DM)., Method: From the Danish part of the ADDITION study, we randomly selected 120 T2DM patients at baseline of the ADDITION study. Analysis of the ECG strips was performed using two different methods: (1) by experienced technicians using rulers and (2) by experienced technicians using a high-resolution computer-assisted method. Calculation of heart rate and time domain HRV [standard deviation of normal-to-normal RR intervals (SDNN) and root mean square of successive differences (RMSSD)] were performed with the same software., Results: When comparing results from the two methods, the following values of Pearson's r are obtained: 0.98 for heart rate, 0.76 for SDNN, and 0.68 for RMSSD. These results indicate that heart rate and HRV measurements by the computer-assisted and manually based methods correlate. However, Bland-Altman plots and Pitman's test of difference in variance revealed poor agreements (p < .01) for both HRV measurements (SDNN and RMSSD); only heart rate showed substantiated agreement (p = .54) between the two methods. Low HRV was statistically significantly associated to high heart rate, systolic blood pressure, and diastolic blood pressure in these screen-detected T2DM patients., Conclusions: Paper ECG strips may contain overlooked clinical information on the status of autonomic function in patients with T2DM. In our study, manual measurements of RR intervals were inferior to the computer-assisted method. Based on this study, we recommend cautiousness in the clinical use and interpretation of HRV based on manual or low resolution measurements of RR intervals from ECG strips. High resolution measurements of RR intervals reveal significant associations between low HRV and high heart rate, systolic blood pressure, and diastolic blood pressure among patients with screen-detected T2DM. It is feasible to use a computer-assisted method to determine RR intervals in patients with T2DM., (© 2012 Diabetes Technology Society.)

Primary care services in or alongside emergency departments look and function differently and are described using inconsistent terminology. Research to determine effectiveness of these models is hampered by outdated classification systems, limiting the opportunity for data synthesis to draw conclusions and inform decision-making and policy. We used findings from a literature review, a national survey of Type 1 emergency departments in England and Wales, staff interviews, other routine data sources and discussions from two stakeholder events to inform the taxonomy. We categorised the forms inside or outside the emergency department: inside primary care services may be integrated with emergency department patient flow or may run parallel to that activity; outside services may be offered on site or off site. We then describe a conceptual spectrum of integration: identifying constructs that influence how the services function-from being closer to an emergency medicine service or to usual primary care. This taxonomy provides a basis for future evaluation of service models that will comprise the evidence base to inform policy-making in this domain. Commissioners and service providers can consider these constructs in characterising and designing services depending on local circumstances and context., Competing Interests: Competing interests: JB is seconded part time to the post of National Clinical Director for Urgent Care at NHS England., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

IntroductionDevelopments in information and communication technologies have enabled electronic health and seen a huge expansion over the last decade. This has increased the possibility of self-management of health issues.PurposeTo assess the effectiveness of the Baby Buddy app on maternal self-efficacy and mental well-being three months post-birth in a sample of mothers recruited antenatally. In addition, to explore when, why and how mothers use the app and consider any benefits the app may offer them in relation to their parenting, health, relationships or communication with their child, friends, family members or health professionals. METHODS: We will use a mixed-methods approach, a cohort study, a qualitative element and analysis of in-app data. Participants will be first-time pregnant women, aged 16 years and over, between 12 and 16 weeks of gestation and recruited from five English study sites.Evaluation planWe will compare maternal self-efficacy and mental health at three months post-delivery in mothers who have downloaded the Baby Buddy app compared with those that have not downloaded the app, controlling for confounding factors. Women will be recruited antenatally between 12 and 16 weeks of gestation. Further follow-ups will take place at 35 weeks of gestation and three months post-birth. Data from the cohort study will be supplemented by in-app data that will include, for example, patterns of usage. Qualitative data will assess the impact of the app on the lives of pregnant women and health professionals using both focus groups and interviews.EthicsApproval from the West Midlands-South Birmingham Research Ethics Committee (NRES) (16/WM/0029) and the University of the West of England, Bristol, Research Ethics Committee (HAS.16.08.001).DisseminationFindings of the study will be published in peer reviewed and professional journals, presented locally, nationally and at international conferences. Participants will receive a summary of the findings and the results will be published on Best Beginnings' website.

The article offers historical information on the English commercial paper pattern industry from 1878 to 1950. In 1878 and 1879, Leach's and Weldons were the first major English commercial paper pattern companies. Between 1878 and 1903, a number of dressmakers' pattern makers opened for business. Scott & Co. manufactured Scott's Paper Patterns for ladies, gents, and children from 1914 to 1941. Maudella Pattern Co. Ltd. started producing patterns under various brand names in the 1930s.

An essay is presented on the history of the Norbury family and their relationship with British composer Edward Elgar in England. It offers history of the social and cultural life of Winifred Norbury and his family in the 1930s in Malvern and Sherridge and their works with Elgar's music. It also looks into the letters, diaries, and other papers and documents depicting the continuity of the family in a house and their communication practices in the social context.